Batty

Batty returned home on Wednesday. He hadn't eaten in the three days that he was at the hospital but we expected that.

Arriving back at home, I had to get him out of the car. He was too weak to climb down from the car on his own, and it was very difficult to pick him up from inside the back seat of the car. Fortunately, we had hung a 帆布 sheet in the back that we use whenever the kids get in the car with us. I was able to detach the sheet from the front and back seats, grab the edges and lift it up with Batty in the middle. Back inside the house area, I gently put the sheet with Batty inside down on the ground. Batty got up and walked inside.

Eating has been a problem. Even back home, Batty hasn't really wanted to eat. We tried all kinds of foods including dog food, raw meat, cooked Chinese food, and milk. He did drink some milk but not a lot. On Thursday however, my wife discovered that if we fed the food to him by hand one mouthful at a time, he would actually eat it. So, 3 or 4 small hand-fed meals a day, Batty is slowly regaining his strength.

Blood sugar is not yet a problem, thankfully. We'll deal with that when it returns, if it returns :-)

Our dog Batty had a second operation yesterday to try to identify and remove an insulinoma from his pancreas. Unfortunately, removal was not possible. We will now have to try various medications to keep his insulin in check and maintain healthier blood glucose levels.

Batty is our 4th dog. 12 years ago, we rescued him from the R.S.P.C.A. (as it was known at the time). He was too young for them to look after. He needed to be hand fed milk and they didn't have enough staff to handle it. But I was there when a Caucasian lady brought him in, and I took him home rather than let them put him down. He was only as big as my hand!

He's had a good life, but not a great life. Several years ago, he was diagnosed with Cauda Equina Syndrome (Horse Tail Syndrome) where the spinal canal narrows over time, pressing down on the spinal cord causing damage and chronic pain. He's been on pain killers for most of those years and has been quite well.

But (and I'm leaving out a lot of details...) in August, Batty began coming to us at night as we slept, waking me up by panting heavily into my face. I'd get up, give him a small dose of pain killer (vet's advice) and go back to sleep. That worked fairly well, but the condition worsened. Within a few weeks, the pain killers were not helping him. The condition continued to get worse until I spent whole nights; from 1am till the sun came up; calming him down and trying to make him comfortable. We thought it was all related to the Cauda Equina. We were wrong.

I despise it when a pre-existing illness/disease makes it difficult to realise that there's a separate serious problem going on.

We talked a few times to our vets and after x-raying his heart and lungs (possible causes of excessive panting...), we arranged an ultrasound to get a closer look at the inner workings of his heart. It was by chance during the ultrasound session that one of the vets noted that Batty had low blood sugar which raised suspicions about a separate illness completely unrelated to the heart. A few days later, we starved Batty for almost a day and measured as his blood sugar dropped. At the time of lowest blood sugar in the day, we took blood for an insulin test. The results came back a few days later. Sugar was low but his insulin was extremely high. Batty had Hyperinsulinism, probably Insulinoma.

In mid-September, the day after we moved house, Batty had an operation to explore his pancreas and remove any nodules found. The vet couldn't with absolute certainty observe or distinguish any nodule/s in the pancreas, so they took out half his pancreas; standard procedure. Slowly, he recovered from the major surgery (although he hated being in hospital, especially when we weren't there) and he seemed fine. Unfortunately, you can't be sure if the surgery was a success until at least 60 days after the surgery, and a couple of weeks ago, we noted that Batty's symptoms were coming back though not nearly as bad as prior to the operation.

So, after a lot of personal research and many conversations, another operation has been organised for Batty (the day after I return from Taipei). With any luck, any nodules present in the pancreas will have grown since the last operation, allowing the vets to see them. Our research also came across a blue compound (not available in Hong Kong) that will very likely allow the vets to visually identify concentrations of insulin within the pancreas. If they can't see anything, they'll just take out as much pancreas as they can, leaving enough for his normal day-to-day digestion requirements.

In the meantime, we're trying to keep Batty as comfortable as possible. One of the challenges of diagnosing and helping pets is the lack of communication. During my research, I was fortunate to come across a web forum of people suffering from chronic hypoglycaemia. It was revealing and extremely helpful to read their posts, describing the physical and emotional symptoms of acute hypoglycaemia, and the methods they used to get by. Especially revealing was the fact that many of these people suffered severe hypoglycaemia at night; the same as Batty; with some pretty depressing symptoms.

One thing vital to dealing with chronic hypoglycaemia is eating the right food at the right time, producing a constant gradualstream of glucose to the body. Gradual means no carbohydrates, especially simple carbohydrates. Here's where dogs and humans differ. Where people need a lot of carbohydrate to survive, dogs need very little and don't need grains at all! Dogs thrive better on a diet of high protein, high fat and none of the grains/carbohydrates that humans generally eat except for leafy vegetables.

So, more research later... Batty now gets multiple meals of B.A.R.F. raw meat product each day. We need to experiment to see how to interval the meals, and how much to feed him each time, but we're making progress. Especially important is a big meal before we sleep at night; another big NO in the human world of healthy eating; but the big protein meal before sleeping means that Batty doesn't experience severe hypoglycaemia at night, and that's good for all of us.

Reference note. The B.A.R.F. food is expensive. All of our kids want to eat it, but we'd have to be really wealthy people to afford B.A.R.F. for all of them; at least HK$20,000 per month! Ouch!!!

Batty in all likelihood has had Hyperinsulinism/Hypoglycaemia for a few years. Again, the pre-existing Cauda Equina influenced us to not look for another problem, but he has several physical symptoms related to long term hypoglycaemia including muscle wasting and twitching.

The next operation probably won't totally eradicate the Hyperinsulinism/Hypoglycaemia, but both should be much easier to manage, allowing him to live much more comfortably. The days that Batty spends in hospital will be hard for both Batty and myself, because I'll spend most of my time being with him in the hospital to keep him calm until he's well enough to come home; with any luck 3 days, but if the operation is successful, 3 or 4 days of suffering will absolutely be worthwhile.

This very minute, Batty is lying on the floor next to my desk, sleeping comfortably and breathing steadily without stress in his eyes. It's very good to see.

People sometimes ask me if looking after 11 dogs is expensive. Well, it is and it isn't. On average, we go through one 15kg bag of dog food each week which isn't too bad. The food cost doesn't scare us. The potential medical cost does.

Over the last month, all of our kids have had all of their shots including one for Heart Worm, a combo 5-in-1 shot, and yesterday the mandatory Rabies shot. Because we have 11 kids, we don't go to the vet. The vet comes to us. The home visit costs extra but everything gets done quickly and smoothly. Fortunately, the vet (and other vets in the past) is good to us; we don't usually have to pay full fee because they're aware that our kids are rescues, and that we have 11 of them.

But medical costs include more than just the shots. One of our kids, Batty, has a back problem that nobody has been able to diagnose despite expensive examinations, x-rays and MRIs. In the early stages of the problem, he would go for a run and be in pain the next day. For a while, we thought it might be something called 'Tying Ups' but that proved to be wrong. He was also tested for hip dysplasia because he's part German Shepherd but that too was incorrect. We have had muscle biopsies sent to the U.S., and they've shown that he has muscle atrophy so it's quite possibly a spinal nerve problem. All of these examinations cost money, and since there's only one company in Hong Kong that provides MRI services, they can charge a lot for it.

Unfortunately, Batty's condition is worsening. He was doing ok until a couple of weeks ago, two of the other kids on two separate occasions accidentally landed on his back in their excitement at seeing us return home. Since then, Batty has been in more pain and is very uncomfortable even while taking daily pain killers.

We're reaching for straws now. I've ordered copies of the MRIs and x-rays. Our vet yesterday said that he has a few friends who can read the MRIs. I'll give the copies to him and see if they can recognise anything. If nothing comes of that, I'll send the copies over to L.A. to a renowned chiropractic vet there recommended by a nice couple I met while staying in Studio City. And if all that fails, I'll arrange to take Batty to a 'Chirovetpractic' in Florida who claims that Batty is a typical mis-aligned sacrum patient, and that he can fix Batty with a simple examination and realignment of his spine and sacrum. To most vets, he sounds like a snake-oil salesman, a seller of hopes, a 'cowboy' as one of my friends calls them, but it might be worth a try anyway, especially since the fees for his services are not unreasonable. It's the air travel to and fro that will cost big pennies!

Occasionally, the kids get into a scrap and they'll get a hole or a rip. Most of these simply need antiseptic cream and time to heal. Beethoven once had a severe rip in his ear, so severe that you could see the soft bone (軟骨 Chinese terminology ;-) within, but even that healed up on its own. In fact, after a week or two, we were advised to stop applying antiseptic cream to the wound because it was interfering with the healing process!

Most of our kids are between eight and nine years old now. As they get older, there will no doubt be more sickness and illnesses to deal with. That's a little scary, but they're truly wonderful companions, and keeping them well is worth every cent!

Four of our kids are on medication twice a day. We wrap the medication up in small strips of cheese so that we don't need to shove the medication down their throats and nobody gets defensive although the healthy guys do tend to look on despondently; "where's my treat?".

Him Him has mild arthritis in one of her front knees and gets anti-inflammatories twice a day.

Charlie has a skin ailment on his front left leg which he incessantly licks hence a secondary bacterial infection. He's now on antibiotics and something else (a blue tablet) twice a day to fight the infection from inside, in addition to cleaning with hibiscrub and the application of a cream to fight the infection from the outside.

Beethoven has a slight skin infection so he's on antibiotics twice a day and getting a medicated bath twice a week. In addition, he sprained a joint during a scuffle on the weekend and is on anti-inflammatories for a few days to keep the swelling and pain down.

And then there's Batty. A few weeks ago, we thought he had hip-dysplasia but the xrays didn't show it. We were referred to another vet on Peace Avenue who suspected Cauda Equina. The subsequent MRI seemed to show narrowing of the spinal tunnel but the analysis of the MRI by an overseas professional, and a further hands-on investigation of Batty's joints and muscles seemed to contradict this. We are once again left with the suspicion that he has Tying Up. To put our suspicions to rest once and for all, Batty was put under full anesthesia and samples were taken from several of his hind section muscles to be sent to a lab in Canada. He is now recovering from that ordeal, and getting pain relief tablets, anti-inflammatories and something else.

Batty is kid #4, rescued as a pup the size of my palm from the R.S.P.C.A. (now the S.P.C.A.) who were going to put him to sleep because he was so young that he would need to be hand-fed. Lucky for both of us, I just happened to be there when the Caucasian lady who had discovered him brought him in.

I insist on being with our kids whenever they need to go under full anesthesia. I want them to be as comfortable as possible. 45 minutes before they go under, they are given a relaxant. Yesterday after getting the relaxant injection, Batty and I walked around the block at a very casual pace. Ten minutes later, we were in the car and Batty was totally out of it. I carried him into the vet's surgical area at 2.30pm and watched as they gave him the full anesthesia injection.

I hate watching them go under because it so closely resembles dying. It reminds me that one day, they will leave us and that's not something I want to dwell on. Nonetheless, I insist on being there whenever they need to be sedated.

Upon returning home yesterday, Batty cried as I tried to lift him out of the car. He was in too much pain. I had to sit down beside him for a few seconds and then coach him out of the car. Once on the ground, he was able to walk for a little but the pain of the biopsy cuts and the drowsy effect of the anesthesia was too much for him. As he stood there unable to move, I bent down, picked him up in my arms and brought him home. He's feeling better now but is still in pain. It will probably be a few days before the pain subsides. If we can find the source of his problem, the pain and cost will be worth it.

Batty's muscle biopsy reports should be available in two weeks. Hopefully, they'll find something, and hopefully, it'll be something treatable. Today, the Typing Up problem evident in horses and dogs is not well understood and no one knows how to treat it, only how to lessen it's affects on the animal.